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Klinische Untersuchung des distalen Radioulnargelenks

Clinical examination of the distal radioulnar joint

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Zusammenfassung

Hintergrund

Das distale Radioulnargelenk (DRUG) stellt aufgrund seiner Verbindung zwischen Elle und Speiche den zentralen Drehpunkt für die Pro- und Supination dar. Diese ermöglichen es – zusammen mit der Schulter – die Hand im Raum optimal zu positionieren, um Gegenstände zu ergreifen. Auch können Gegenstände, die sich in der Längsachse des Unterarmes befinden, durch die Bewegung im DRUG in Drehung versetzt werden. Somit stellt das DRUG eine wichtige Rolle dar, um „daily life activities“ durchführen zu können.

Diagnostik

Aufgrund seiner Nahbeziehung zu den angrenzenden Gelenken ist die klinische Diagnostik des DRUG meist erschwert, da sich die Beschwerden in der Regel überlappen. Daher muss eine klinische Untersuchung exakt durchgeführt werden, um den Ursprung der Beschwerden des Patienten eingrenzen zu können. Es steht eine Reihe von klinischen Untersuchungstechniken zur Verfügung, die jedoch von der Erfahrung des Untersuchers abhängig sind und zumeist bezüglich Sensitivität und Spezifität nicht mit dem Goldstandard, der Handgelenksarthroskopie, verglichen sind. Die am besten evaluierten klinischen Untersuchungstechniken sind das „ulnar fovea sign“, der dorsopalmare Stresstest und der Press-Test. Diesen Testverfahren sollte in der klinischen Diagnostik der Vorzug gegeben werden.

Abstract

Background

The distal radioulnar joint (DRUJ) provides the distal link between radius and ulnar and is the centre of rotation during pronation and supination. Pronation and supination are essential in controlling the posture and optimal presentation of the hand to grasp an object. In addition, pronation and supination enable us to rotate tools when they are in the longitudinal axis of the forearm. Due to this, the DRUJ plays a central role in the performance of activities in daily life.

Diagnostics

Examination of the ulnar-side of the wrist remains challenging for hand surgeons due to a wide range of pathologies with overlapping clinical symptoms. Therefore, the clinical examination must be carried out carefully to detect the origin of the patient’s complaints. Several special examination techniques are available, but their application and interpretation strongly depend on the skills and experience of the physician. Most tests are not evaluated in comparison to the gold standard of wrist arthroscopy with respect to sensitivity and specificity. The most reliable test for the DRUJ are the ulnar fovea sign, the dorsopalmar stress test and the press test.

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Abbreviations

DRUG:

Distales Radioulnargelenk

ECU:

Extensor carpi ulnaris

FCU:

Flexor carpi ulnaris

LT:

Lunotriquetral

TFCC:

Triangular fibrocartilaginous complex

USTI:

Ulnar styloid-triquetral impaction

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Authors and Affiliations

  1. AUVA Unfallkrankenhaus Lorenz Böhler – European Hand Trauma Center, Donaueschingenstraße 13, 1200, Wien, Österreich

    S. Quadlbauer, C. Pezzei, T. Hausner & M. Leixnering

  2. Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie, AUVA Research Center, 1200, Wien, Österreich

    S. Quadlbauer & T. Hausner

  3. Austrian Cluster for Tissue Regeneration, 1200, Wien, Österreich

    S. Quadlbauer & T. Hausner

  4. Ordination für Handchirurgie, 2100, Korneuburg, Österreich

    W. Hintringer

  5. Abteilung Orthopädie und Traumatologie, Paracelsius Medizinische Universität, 5020, Salzburg, Österreich

    T. Hausner

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  1. S. Quadlbauer
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Correspondence to S. Quadlbauer.

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S. Quadlbauer, C. Pezzei, W. Hintringer, T. Hausner und M. Leixnering geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Quadlbauer, S., Pezzei, C., Hintringer, W. et al. Klinische Untersuchung des distalen Radioulnargelenks. Orthopäde 47, 628–636 (2018). https://doi.org/10.1007/s00132-018-3584-x

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